Steroids? Antibiotics? Buster....(and anyone else)

[eljomom]

WE are looking at possibly doing a steroid taper for dd (just turned 7), who has done a month of augmentin and now about 2 1/2 weeks on zithromax, with not much help. Many, many tics that started in June after a high fever (not strep) followed by 3 months of exposure and 2 illnesses with staph impetigo. Also, more hyper, super strong sep. anxiety, and ocd more prevalent. Before that, a few tics this spring after walking pneumonia. Before that, ocd a couple years ago (still going on).....numerous respiratory illnesses, pneumonia, fevers, etc.....never took in for strep (my older 3 kids had it all the time).

 

Anyhow, I worried about the taper---in light of what I read about steroids causing BOTH Th1 and Th2 (?) to be supressed, thus causing any underlying virus/bacteria to strengthen, etc. Plus, still not 100% sold it's not TS. Dr. Latimer says pandas. Dr. Leckman, just in an e-mail, said that since she's not improving on antibiotics, it's less likely to be pandas. That really struck me as odd, given so many of these kids get progressively worse, especially if treatment is delayed so long like it has been with us. Can you shed any light on this assumption? Also, any explanation why steroid taper would be good or bad idea, if abx aren't helping?

 

One other thing---still not understanding, and is the fact that if PANDAS is autoimmune, how can it be stopped dead in its tracks for some people JUST with antibiotics??? Also, if this is a longer-term autoimmune issue, then is it simply ridding the child of the bacteria or virus that caused it, or do we now have to deal with a "garden-variety"--well, not really, more of a BBB autoimmune issue, more important than just giving abx?? Does this make sense?

 

Thanks for any details. Brain is a-humming!

[Buster]

Sigh, this is a complicated topic. You might write to Dr. Leckman and ask him the rationale or perhaps a paper reference supporting his position. Currently PANDAS is thought to be caused by three things:

1. the activation of an abnormal antibody response to an antigen (often GABHS) that targets neuronal tissue
   
2. a failure to suppress the "self" antibody response (sometimes referred to as Treg)
   
3. a breach of the blood brain barrier that allows the antibody to reach neuronal tissue
   

 

Prednisone affects all three parts by reducing antibody production (1) and (2) and being highly anti-inflammatory and potentially closing the Blood-brain barrier.

 

Antibiotics can help the immune system overcome antigens by slowing the progress of the antigen. Antibiotics do not "kill" bacteria (in the tradtional sense), they just slow down the bacterial growth so that the immune system can kill the bacteria. This means that you basically need a working immune system to kill a bacterial infection.

 

Okay, so when you use Prednisone, it is immuno suppressive. It dramatically reduces the feedback loop that causes activation of T-cells and release of antibodies by B-cells. If you have already been on antibiotics for an extended period of time, it is unlikely that pred would cause increased activation of the bacteria. Most of the time bacteria is kept in check by other bacteria competing for the same building blocks.

 

People on predinsone shouldn't be around people with colds/flu/bacterial infections because yes they have weaker immune responses.

 

Dr. K tends to refer to the prednisone burst as confirmatory because if you do see a dramatic improvement when on pred you are likely seeing either the anti-inflammatory effect or the immuno suppressive effect therefore highlighting a likely auto-immune issue.

 

Hope that helps,

 

Buster

 

 

WE are looking at possibly doing a steroid taper for dd (just turned 7), who has done a month of augmentin and now about 2 1/2 weeks on zithromax, with not much help. Many, many tics that started in June after a high fever (not strep) followed by 3 months of exposure and 2 illnesses with staph impetigo. Also, more hyper, super strong sep. anxiety, and ocd more prevalent. Before that, a few tics this spring after walking pneumonia. Before that, ocd a couple years ago (still going on).....numerous respiratory illnesses, pneumonia, fevers, etc.....never took in for strep (my older 3 kids had it all the time).

 

Anyhow, I worried about the taper---in light of what I read about steroids causing BOTH Th1 and Th2 (?) to be supressed, thus causing any underlying virus/bacteria to strengthen, etc. Plus, still not 100% sold it's not TS. Dr. Latimer says pandas. Dr. Leckman, just in an e-mail, said that since she's not improving on antibiotics, it's less likely to be pandas. That really struck me as odd, given so many of these kids get progressively worse, especially if treatment is delayed so long like it has been with us. Can you shed any light on this assumption? Also, any explanation why steroid taper would be good or bad idea, if abx aren't helping?

 

One other thing---still not understanding, and is the fact that if PANDAS is autoimmune, how can it be stopped dead in its tracks for some people JUST with antibiotics??? Also, if this is a longer-term autoimmune issue, then is it simply ridding the child of the bacteria or virus that caused it, or do we now have to deal with a "garden-variety"--well, not really, more of a BBB autoimmune issue, more important than just giving abx?? Does this make sense?

 

Thanks for any details. Brain is a-humming!